Unknown, unplanned pregnancy linked to delayed prenatal care

Key takeaways:

• Transitions, cancellations and unplanned/unknown pregnancy were the top reasons for care delay.
• Women with delayed care were more likely to speak Spanish, be younger and have longer time from conception to care.

Periods of transition, unplanned pregnancy, no shows or patient cancellations and being unaware of one’s pregnancy were the most common barriers to starting prenatal care, according to a mixed-methods study.

“Though family health centers exceed the Healthy People 2030 goal that 80.5% of pregnant patients receive prenatal care during their first trimester, efforts to ensure this care gap decreases and to target the most vulnerable patients remain a priority,” Valerie N. Holt, DO, MPH, family medicine resident physician and public health professional at the School of Osteopathic Medicine at A.T. Still University, and colleagues wrote in BMC Pregnancy and Childbirth. “The composition of its patient population, in combination with its relatively robust data infrastructure, make family health centers an ideal health system to evaluate.”

Holt and colleagues conducted an initial chart review for 169 pregnant women (mean age, 27.8 years) who initiated prenatal care after their first trimester at a large federally qualified family health center in Brooklyn, New York, from August 2021 to July 2022. For each woman, researchers determined primary and secondary patient-specified reasons for prenatal care delays.

Mean gestational age of entry into prenatal care was 19 weeks. Overall, 8% of women in the study had recently moved to Brooklyn from outside New York City or the United States, 9% had difficulties scheduling an initial prenatal visit within their first trimester and 7% were teenagers.

Researchers observed the following as the most common prenatal care delay themes:

• patients being in periods of transition (21.2%);
• unplanned pregnancy (16.8%);
• issues with linkage to care, such as no shows or patient cancellations (15.5%); and
• patients being unaware of their pregnancy (9.7%).

Women late to prenatal care were more likely to be Spanish-speaking, to be younger and to experience a relatively long delay between pregnancy confirmation and prenatal care entry. In addition, researchers observed patient age at the initial prenatal visit as the primary determinant of delayed prenatal care entry.

“Future initiatives include the introduction of a smart data element to encourage consistent documentation of the reason for delay. Additionally, we aim to dedicate community health workers for targeting outreach and follow up after delayed prenatal patients have no show appointments or cancel without rescheduling,” the researchers wrote. “We plan for evaluation of future quality improvement initiatives to determine their impact on reducing delayed initiation of prenatal care and mapping that to improved quality of care and positive maternal and infant outcomes at delivery.”